Organization Active NPI

Kruse Chiropractic, LLC

  • Chiropractor
  • Waterloo, IL
National Provider Identifier
1023488293
Registry record updated Oct 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
KRUSE CHIROPRACTIC, LLC
Practice address
208 E Mill St
Waterloo, IL 62298-1519
Phone
(618) 410-2855
NPI assigned
Oct 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Emily Michele Kruse, D.C.NPI 1780067256
Title
Manager
Phone
(618) 410-2855

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

208 E Mill St
Waterloo, IL 62298-1519

Mailing address

208 E Mill St
Waterloo, IL 62298-1519

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151007003197 IL Part B Supplier - Clinic/Group Practice 7911215173 Receives reassigned benefits from 1 practitioner
Practice locations: Waterloo, IL

National Provider Directory

National Provider Directory

Locations

208 E Mill St
Waterloo, IL 62298
Phone (618) 406-1342

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443657600000",
    "number": "1023488293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 E MILL ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 E MILL ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981519",
            "telephone_number": "618-410-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRUSE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-01",
        "last_updated": "2015-10-01",
        "status": "A",
        "authorized_official_last_name": "KRUSE",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "618-410-2855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.